Alabama’s New “Midwife Decriminalization Bill” Actually does the Opposite: It Criminalizes Traditional Midwives

On the final day of Alabama’s legislative session, Alabama lawmakers passed HB315, the “midwife decriminalization bill.” After an amendment was added by Senator Paul Bussman of Cullman, it actually became a CPM (Certified Professional Midwife) licensure bill, and it was placed on Governor Kay Ivey’s desk at 9:04 pm Friday night for her signature.

There are a number of problematic issues with this amendment, but this is the most serious for birthing mothers in Alabama:

Women wanting VBACs (Vaginal Birth after Cesarean) are excluded from access to a legal homebirth in Alabama with the newly legalized CPMs. On page 11 of the final bill, which includes the Bussman amendment, VBAC is defined as being “outside the scope of the licensed practice of midwifery.”

Considering the fact that the C-section rate in Alabama is more than 1 in 3 (36.5%), and that there are some hospitals and doctors who refuse to “allow” VBACs, and others that give lip service to VBACs, but impose such tight restrictions that it is very difficult to get one in most hospitals in the state, this is very bad news for mothers who want to choose the safer option for her and her baby.

VBAC is safer than repeat c-section for both mother and baby, and carries lower risks of infant and maternal mortality. (Source.)

Also, in this new law, traditional midwives and non-CPM homebirth midwives are “guilty of a Class C misdemeanor” for attending homebirths.

HB315, as it went into Friday’s session, was probably the best bill ever presented to the Alabama Legislature by the Alabama Birth Coalition, a group of Certified Professional Midwives and citizen advocates for licensing them.

It simply decriminalized CPMs and stated that other midwives who practiced were guilty of a violation. Though it was not perfect, it came the closest to being more about the rights of women to make choices for their births than any other bill they have presented in 15 years or more in the state.

Ideally, any laws passed should secure a woman’s God-given, inherent right to birth where and with whom she chooses, i.e. “Birth Freedom.” Some midwives and advocates in the homebirth community have long argued that, too often, laws surrounding midwives ultimately place control of women and birth in the hands of organizations and legislators rather than where it actually belongs – with the women giving birth.

Well-meaning activists have unwittingly surrendered the rights of their daughters and friends to make decisions about their own births, and governmental regulations end up defining for women who may, and who may not, legally use their own birth canal to give birth in their own home attended by a midwife.

Unfortunately, the Bussman amendment may have just that effect. Besides eliminating VBACs, CPMs under this amendment will not legally be permitted to attend women whose babies are breech or women expecting twins or multiples – both of which are variations of normal.

Skilled midwives throughout human history have been trained in dealing with such situations, while the majority of obstetricians have lost those skills, relegating most mothers in those situations to cesarean sections.

C-sections carry a greater risk of harm or death to mothers and babies than vaginal births. (Source.)

The amendment was added in the late afternoon of May 20, and passed both houses by 7 pm on the last day of the legislative session.

Supporters rejoiced and cried tears of joy that “midwives are finally legal in Alabama.”

I do not see cause for rejoicing.

There are many in the homebirth and midwifery community who recognize the dangers of such legislation. They have seen what it has done in other states, and they are well-aware of the slippery slope it creates. They cried tears of grief for the daughters and granddaughters whose freedom to birth as nature intended just got smaller.

Gail Hart is one of the most respected midwives in the world. She is a frequent guest at midwifery conferences, and is on staff at Ancient Art Midwifery Institute, which was founded in 1981 by Carla Hartley. Gail recently addressed some of the concerns about the licensure of midwives:

The mothers are in charge of their bodies. This is a basic human right and it is enshrined in the US Constitution. A woman has a right to choose anyone or no one to help her in birth.

It is her responsibility to choose carefully. It is not the state’s responsibility to limit her choice to a tiny group who may not represent the skills or philosophy the woman desires.

Let the women decide. Do not make criminals of their birth attendants.

There is one ray of hope in the new Alabama midwife bill. Within the text of the bill, it states that someone is not in violation of the law if “the individual is providing gratuitous assistance at childbirth.” As long as the birth attendant is not being paid for the birth, mothers still retain the inherent right to birth where and with whom she chooses.

For 1 out of 3 mothers who have had a cesarean, that may be little comfort for those wanting a homebirth in order to avoid repeating the major abdominal surgery in the future.

According to a recent Consumers Report, 90% of women who had a first C-section will end up with a repeat cesarean. Often women who want to have a good chance at a VBAC choose homebirth with a midwife, because the chances of a successful VBAC are much greater in a homebirth setting.